Smoke in a surgical field is a common problem, particularly during laparoscopic and robotic procedures, that arises from the use of electrosurgical instruments, lasers, and other devices. Typically, smoke is vented out through one of the instrument ports, too often with slow and imperfect results. Alesi Surgical, a company out of Cardiff, Wales, offers a technology that significantly improves on simple ventilation (see video at the bottom of this post). We spoke with Dominic Griffiths, PhD, Managing Director of Alesi Surgical, about how the company’s Ultravision technology works, how it was developed, and what the benefits are for the surgical team.
Medgadget: Smoke during minimally invasive laparoscopic and robotically assisted surgery can really spoil a scene. Ventilation is an obvious solution, but Alesi Surgical’s system uses an electromagnetic approach. Can you please describe how Ultravision technology works?
Dominic Griffiths: Ultravision works on the principle of electrostatic precipitation. Electrostatic precipitation accelerates the normal process of sedimentation and is a proven, widely used method of clearing airborne vapour and particulate matter in industrial applications.
Ultravision introduces a small, transient electrostatic charge into the gas (carbon dioxide) that is used in laparoscopic surgery to create a working space inside the abdominal cavity. This low energy charge (a “plasma”) causes rapid and continuous precipitation of the vapour that is produced by electrosurgical instruments. The charge is supplied by an ‘Ionwand’ electrode which is introduced to the abdominal cavity, either using a dedicated catheter – requiring a small incision that does not require suturing and can be dressed using a surgical plaster – or the new Ultravision 5mm Trocar. Ultravision is a low energy device, using 500 -1,000 times less energy than electrosurgical instruments.
Medgadget: Is this kind of technology used in other industries to control particulate pollution?
Griffiths: Yes, it is widely used in other industries such as cement manufacture, coal production, paper manufacture and in pharmaceutical clean rooms, for example. It is a highly efficient process for removing particulate matter from the atmosphere and is therefore very useful for removing such vapour and particles from waste gases.
Medgadget: Why is simple ventilation not sufficient, and does Ultravision require moving air in and out of the surgical volume?
Griffiths: ‘Venting’ the smoke into the operating theatre by opening one of the gas valves on a trocar has historically been used to improve the view. However, this has several drawbacks in terms of potential impact on the patient and staff in the operating room.
The process is a ‘dilution-based’ process and is inefficient and slow in clearing the view. Imagine a small glass of orange juice – how much water would you have to add to that glass to make the orange colour disappear? A lot! This is the process of dilution and is the same for venting to improve the view. In terms of patient impact, it results in a dramatic increase in the amount of carbon dioxide that a patient is exposed to during a procedure and this has implications. For example, the carbon dioxide is 21C and zero humidity, which rapidly desiccates tissue and is linked to the incidence of the formation of post-surgical ‘adhesions’ where the surgical site is repaired incorrectly by the body, which can lead to the requirement for a further procedure. It also reduces core body temperature because the patient is being chilled from the inside by the excessive gas. Reduced body temperature is linked to longer time in recovery, post-surgical pain and an increased risk of post-surgical infection. Patients exposed to excessive carbon dioxide may also have additional stresses on the cardiovascular system which can complicate anaesthesia.
Because venting is not very efficient, the procedure is inefficient i.e. slowed down, which lengthens procedure time and the patient’s time under anaesthetic. From an administrator perspective, this means that the hospital is not optimising the efficiency of its expensive resources.
In terms of staff impact there is increasing concern that long-term exposure to the smoke released into the operating room may have a health and safety impact on the staff. Some, but not all, hospitals use ‘filters’ to try and remove the smoke as it is released from the abdomen, but this slows the rate of clearing the view even more and so surgeons have often tended to be reluctant to adopt these.
Ultravision is the only technology that we are aware of that rapidly and continuously clears the smoke from the visual field without requiring gas exchange and filtration. It is the only product that provides maximum view with minimum carbon dioxide exposure.
Medgadget: Can you tell us about the latest clearance of the accompanying trocar?
Griffiths: The Ultravision 5mm Trocar is a ‘line extension’ that provides an alternative consumable to the original ‘Ionwand pack’. We received surgeon feedback that in some procedures it would be beneficial to co-locate the Ionwand electrode with the cutting or grasping instrument. Integrating the channel for the Ionwand electrode with the channel through which such instruments pass, i.e. a 5mm trocar, seemed the logical solution.
Medgadget: What does it take to introduce this technology into an existing OR?
Griffiths: The buying process involves obtaining buy-in from the surgical team and the administrative team. Practically it involves installing the Ultravision generator – a small, portable, low power generator – and using the Ultravision single-use consumable item i.e. the 5mm Trocar or the Ionwand pack. Importantly it does not require a change to existing surgical practice.
Medgadget: How does managing it compare with existing solutions?
Griffiths: It is certainly very efficient and as noted before is the only system that gives maximum view with minimum carbon dioxide use.
Medgadget: Can you give us a brief history of Alesi Surgical and how it came to develop this technology?
Griffiths: The company was established in 2010 as a spinout from Cardiff University’s Welsh Institute for Minimum Access Therapy (WIMAT). WIMAT is a leading training centre in the UK for laparoscopic and other surgical specialties. One of the founders of WIMAT, Dr Neil Warren, conceived the idea for Ultravision. Neil was very aware of the challenges presented by surgical smoke and the ‘eureka moment’ for this new concept came from a domestic product that uses a similar principle that he bought to try and improve the symptoms of his daughter’s pollen allergy! The company was founded by Fusion IP – since acquired by IP Group PLC – and secured investment from Fusion IP and Finance Wales. The company recently raised a further £5.2m in 2017 which involved securing funds both from existing investors and from new investors Panakes Partners (Italy) and Earlybird (Germany).
Check out this video that demonstrates how Ultravision removes smoke out of a surgical scene:
Product page: Ultravision…